Education or the promise of an incentive improved initial follow-up. Education was superior to an incentive for the completion of therapy. Fairly modest strategies provided in jail can improve adherence. Further links between jail health services and community care should be explored.

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Jails are a unique setting for health education. The Tuberculosis (TB) Prevention Project was designed to improve completion of care for latent TB infection in released inmates. As part of an ongoing clinical trial to improve rates of completion, educators provided TB-focused educational sessions to 1,027 inmates. This article describes the educational sessions and illustrates some of the barriers to working in a jail setting and strategies to overcome them. The nature of the jail itself, inmate characteristics, the characteristics of educators, and the educational sessions themselves interacted in different ways to enhance or impair the interaction. Jail is a setting in which the population is at high risk for a number of health problems and health education is increasingly important.

Recidivism is a pervasive problem facing the incarcerated. Incarcerated persons who are human immunodeficiency virus (HIV)-infected often have multiple risk factors associated with initial incarceration and recidivism, in particular, injection drug use. Yet, some jails provide case management for HIV-infected inmates to provide continuity of health care, which might have positive effects on reentry into the community. We sought to measure recidivism and factors related to recidivism in an HIV-infected cohort in an urban county jail with an active case management program. Fifty-two inmates surveyed in 1999 at the San Francisco County Jail were followed for rearrests through 2006. In follow-up, 73% were re-incarcerated on an average of 6.8 times for 552 days. Risk factors included nonwhite ethnicity, history of homelessness and crack use, common risk factors for incarceration. Less than high school education was associated with recidivism, shorter time to reincarceration, and more incarcerations. HIV-infected inmates spend a high proportion of time in multiple incarcerations, a reflection of the cyclical nature of incarceration despite comprehensive case management. Well-known risk factors for incarceration were associated with recidivism; in addition, lack of high school education played a prominent role. Education should be explored as a way to make further progress on breaking the cycle of incarceration.

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